Complex clinical scenarios with the use of direct oral anticoagulants in patients with atrial fibrillation: a multidisciplinary expert advisory board
Mulder, B. A.; ten Berg, J.; ten Cate, H.; van Es, N.; Hemels, M. E.W.; Kappelle, L. J.; Bearda Bakker, H. B.; de Borst, G. J.; Drenth, D. J.; Geersing, G. J.; Rienstra, M.
(2020) Netherlands Heart Journal, volume 28, issue 10, pp. 504 - 513
(Article)
Abstract
The risk of developing atrial fibrillation (AF) and the risk of stroke both increase with advancing age. As such, many individuals have, or will develop, an indication for oral anticoagulation to reduce the risk of stroke. Currently, a large number of anticoagulants are available, including vitamin K antagonists, direct thrombin or factor
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Xa inhibitors (the last two also referred to as direct oral anticoagulants or DOACs), and different dosages are available. Of the DOACs, rivaroxaban can be obtained in the most different doses: 2.5 mg, 5 mg, 15 mg and 20 mg. Many patients develop co-morbidities and/or undergo procedures that may require the temporary combination of anticoagulation with antiplatelet therapy. In daily practice, clinicians encounter complex scenarios that are not always described in the treatment guidelines, and clear recommendations are lacking. Here, we report the outcomes of a multidisciplinary advisory board meeting, held in Utrecht (The Netherlands) on 3 June 2019, on decision making in complex clinical situations regarding the use of DOACs. The advisory board consisted of Dutch cardiovascular specialists: (interventional) cardiologist, internist, neurologist, vascular surgeon and general practitioners invited according to personal title and specific field of expertise.
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Keywords: Anticoagulation, Atrial fibrillation, Co-morbidities, Direct oral anticoagulant, Stroke prevention, Cardiology and Cardiovascular Medicine, Journal Article, Review
ISSN: 1568-5888
Publisher: Bohn Stafleu van Loghum
Note: Funding Information: The sponsor of the meeting (Bayer) had no influence on the content of the advisory board meeting or in writing of the manuscript. B.A. Mulder, J. ten Berg, H. ten Cate, N. van Es and M.E.W. Hemels received advisory board fees from the sponsor. B.A. Mulder has received a research grant of the ESC council on stroke. M. Rienstra reports research support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial fibrillation: interaction between hyperCoagulability, Electrical remodeling, and Vascular destabilisation in the progression of AF (RACE V). G.-J. Geersing is supported by a personal Veni and Vidi grant from the Netherlands Organization for Health Research and Development (ZonMw); ZonMw had no role or influence in drafting this manuscript. B.A. Mulder, J. ten Berg, H. ten Cate, N. van Es, M.E.W. Hemels, L.J. Kappelle and M. Rienstra attended the meeting and discussed the cases. The sponsor supported the meeting but did not participate in it. H.B. Bearda Bakker, G.J. de Borst, D.J. Drenth and G.-J. Geersing did not attend the advisory board meeting but provided intellectual input and revised the manuscript. Publisher Copyright: © 2020, The Author(s).
(Peer reviewed)
